Occlusal Instability Results in Increased Complication Rates After Treatment of Mandibular Fractures.

PURPOSE: It is important to understand the factors that can increase the incidence of complications after mandibular fracture (MF) treatment. The objective of the present study was to investigate whether occlusal stability influences the occurrence of postoperative complications in MFs treated with internal rigid fixation. PATIENTS AND METHODS: We performed a prospective cohort study of patients treated for MF by osteosynthesis with plate and screw fixation. The primary predictor variable was the occlusal stability (yes vs no). Occlusion was scored as stable (group 1) if the patients had all their teeth and no free ends in either dental arch. Occlusion was coded as unstable (group 2) if the patients were partially edentulous with free ends in either dental arch or had edentulism involving more than 6 dental elements. The primary outcome variable was postoperative complication (yes vs no). The secondary outcome variables were the osteosynthesis system used (2.0 or 2.4 mm), local factors, age, and gender. Statistical analysis was performed using the χ2 statistical test at 5% significance. RESULTS: Of 115 patients with 121 MFs, 73 (63.48%) had stable occlusion (group 1) and 42 (36.52%) had unstable occlusion (group 2). The mean age was 34.11 years, and 71.3% were men. The postoperative complication rate was 8.70% (10 patients). Of the 10 patients with complications, 3 (2.6%) were in group 1 and 7 (6.1%) were in group 2 (P = .021 and P < .05, respectively). The 2.0-mm system was used in 107 cases (93%). All the complications were associated with use of the 2.0-mm osteosynthesis plates, occurring in 3 of 69 patients in group 1 (4.34%) and 7 of 38 patients in group 2 (18.42%; P = .032 and P < .05, respectively). The greatest number of complications was associated with unilateral MF (9 of 109). The occurrence of postoperative complications in angle and symphysis/parasymphysis fracture sites was equal. CONCLUSIONS: The results of the present study suggest that unstable occlusion could increase the rate of postoperative complications in MFs treated with plates and screws. Future studies are required with occlusal stability included as a variable.

Immediate Oral Rehabilitation Using Dental Implants After Marginal Mandibulectomy: A Case Report.

Mandibular reconstruction techniques are always a challenge to oral and maxillofacial (OMF) surgeons. Techniques and treatment plans that offer the patient OMF rehabilitation should always be available. Technological innovations have enabled more rapid, safer, and more secure treatment than in the past. This article describes a case using a different approach. The patient was treated with marginal mandibulectomy and immediate rehabilitation with osseointegrated implants; a hybrid prosthesis was fabricated a short time thereafter. This treatment plan demonstrated its utility and efficiency in this case. An approach with fewer surgeries and OMF rehabilitation needs be considered in all cases.

Dental Implants Can Facilitate Orthognathic Surgery in a Patient With Severe Maxillary Atrophy.

The surgical treatment of dentofacial deformities is performed routinely and predictably in dentate patients. However, when dealing with the edentulous maxilla, treatment becomes more challenging and less predictable. In these cases, the combination of orthognathic surgery and osseointegrated implants could be a viable alternative to enable fixed rehabilitation. A patient with an edentulous and atrophic maxilla with maxillomandibular discrepancy and high esthetic requirement was treated with a combination of osseointegrated implants and orthognathic surgery. The rehabilitative sequence was composed of maxillary grafting procedures, installation of dental implants, placement of a fixed implant-supported prosthesis, and bimaxillary orthognathic surgery. During provisional restoration before orthognathic surgery, smaller teeth were used, allowing achievement of appropriate tooth length for the final restoration, even after natural and expected postoperative relapse. This restorative approach provided an implant-supported fixed prosthesis without prosthetic compensation and with optimum esthetics and biomechanics.

Atypical Intracranial Compound Simil Odontoma.

Odontoma is the most common mixed epithelial and mesenchymal tumour-like malformation which affects maxillary bones. Clinically, Odontomas present as lesions of benign behavior, causing little or no deformity, are asymptomatic, with self-limited growth and usually detected on routine radiographs. Radiographically, they are radiopaque lesions, well-demarcated surrounded by a thin soft tissue capsule. Compound odontomas consist of numerous tooth-like structures, whereas in complex odontomas it consists of a disorganized mass of calcified tissue. The aim of this article was to report an atypical case of intracranial compound odontoma, in the middle cranial fossa, reaching the sphenoidal sinus, which has been followed for 10 years.

Late Complication Associated With the Treatment of Orbital Floor Fracture With Titanium Mesh.

Treatment of orbital fractures involves restoration of lost bone anatomy and orbital volume. Among the materials used for this purpose, the titanium mesh is widely used due to its effectiveness and low complication rate related to distortion especially in non-traumatic events. This study shows an atypical and late complication involving the deformation of the titanium mesh used during reconstruction of the orbital floor in a patient with orbital zygomatic complex fracture 5 months after the procedure and without traumatic etiology.

Sensitive and Motor Neuroanastomosis After Facial Trauma.

Facial nerve has great functional and aesthetic importance to the face, and damage to its structure can lead to major complications. This article reports a clinical case of neuroanastomosis of the facial nerve after facial trauma, describing surgical procedure and postoperative follow-up. A trauma patient with extensive injury cut in right mandibular body causing neurotmesis of the VIIth cranial nerve and mandibular angle fracture right side was treated. During surgical exploration, the nerve segments were identified and a neuroanastomosis was performed using nylon 10-0, after reduction and internal fixation of the mandibular fracture. Postoperatively, an 8-month follow-up showed good evolution and preservation of motor function of the muscles of facial mime, highlighting the success of the surgical treatment. Nerve damage because of facial trauma can be a surgical treatment challenge, but when properly conducted can functionally restore the damaged nerve.

Autogenous bone grafts contamination after exposure to the oral cavity.

The purpose of this paper was to analyze specimens of autogenous bone block grafts exposed to the oral cavity after ridge reconstructions. Specimens of chronic suppurative osteomyelitis (CSO) of the jaws were used as comparison for bacterial colonization pattern. For this, 5 specimens of infected autogenous bone grafts were used and 10 specimens of CSO embedded in paraffin were stained with Brown and Brenn technique and analyzed under light microscopy. The results showed a similar colonization pattern in both situations, with the establishment of bacterial biofilm and the predominance of Gram-positive bacteria. The conclusion was that the similarity in bacterial distribution and colonization between autogenous bone grafts and CSO stresses the necessity of more invasive procedures for the treatment of the autogenous bone grafts early exposed to the oral cavity.

Influence of implant drill materials on wear, deformation, and roughness after repeated drilling and sterilization.

PURPOSE: The aim of this study was to evaluate deformation, roughness, and mass loss of stainless steel, diamond-like carbon (DLC)-coated and zirconia drills after multiple osteotomies with sterilization procedures. MATERIALS AND METHODS: Drilling procedures were performed using stainless steel (G1), DLC-coated (G2), and zirconia (G3) drills. All groups were divided in subgroups 1, 2, 3, 4, and 5, corresponded to drills used 0, 10, 20, 30, and 40 times, respectively. RESULTS: No significant differences in mass and roughness were detected among all groups and subgroups. In SEM images, all groups revealed signs of wear while coating delamination was detected in G2. Drills from G1 displayed more irregular surface, whereas cutting edges were more regular in G3. CONCLUSION: Zirconia drills presented more regular surfaces whereas stainless steel drills revealed more severe signs of wear. Further studies must be performed to evaluate the putative influence of these findings in heat generation.

Photoelastic analysis of conventional and locking system for treatment of mandibular angle fractures with a single plate.

BACKGROUND: This photoelastic analysis evaluated stress distribution in different osteosynthesis systems, conventional and locking, used for treatment of mandibular angle fractures with a single plate. MATERIAL AND METHODS: Angle fractures were simulated in mandibles made of photoelastic resin. Following Champy's method, plate osteosynthesis was performed. The samples were divided into five groups: Group 1, non-fractured mandible; Group 2, two screws were installed in each segment using a conventional system; Group 3, two screws were installed in each segment using a locking system; Group 4, three screws were installed in the proximal segment and four screws in the distal segment using a conventional plate; Group 5, three screws were installed in the proximal segment and four screws in the distal segment using a locking plate. In an universal testing machine coupled to a polariscope, a load was applied to the first molar 10 times. The 50 images were randomly numbered and analyzed qualitatively and quantitatively by two raters. RESULTS: The locking system promoted better stress distribution along the osteosynthesis. The locking system reduced stress magnitude in the distal segment, with a significant between-group difference (P≤ 0.001). CONCLUSIONS: The locking plate/screw system can distribute stress more evenly throughout the osteosynthesis, especially when long seven-hole plates are used. Key words:Internal fracture fixation, osteosynthesis, mandibular fracture, bone plates.

In vitro biomechanical evaluation of the use of conventional and locking miniplate/screw systems for sagittal split ramus osteotomy.

PURPOSE: The aim of this in vitro study was to assess the biomechanical stability of 9 different osteosynthesis methods after sagittal split ramus osteotomy by simulating the masticatory forces and using a 3-point biomechanical test method. MATERIALS AND METHODS: Forty-five polyurethane hemimandibles with bone-like consistency were randomly assigned to 9 groups (n = 5) and subjected to sagittal split ramus osteotomy. After 4-mm advancement of the distal segment, the bone segments were fixed by different osteosynthesis methods using 2.0-mm miniplate/screw systems: group A, one 4-hole conventional straight miniplate; group B, one 4-hole locking straight miniplate; group C, one 4-hole conventional miniplate and one bicortical screw; group D, one 4-hole locking miniplate and 1 bicortical screw; group E, one 6-hole conventional straight miniplate; group F, one 6-hole locking straight miniplate; group G: two 4-hole conventional straight miniplates; group H, two 4-hole locking straight miniplates; and group I, 3 bicortical screws in an inverted-L pattern. All models were mounted on a base especially constructed for this purpose. Using a 3-point biomechanical test model, the hemimandibles were loaded in compressive strength in an Instron machine (Norwood, MA) until a 3-mm displacement occurred between segments vertically or horizontally. Data were analyzed by analysis of variance and Tukey test (alpha = 1%). RESULTS: The multiparametric comparison of the groups showed a statistically significant difference (P < .01) between groups that used 2 miniplates (groups G and H), 1 miniplate and 1 bicortical screw (groups C and D), and only bicortical screws (group I) compared with groups that used only 1 miniplate with 2 screws per segment (groups A and B) and 3 screws per segment (groups E and F). CONCLUSION: The placement of 2.0-mm-diameter bicortical screws in the retromolar region, associated or not with conventional and locking miniplates with monocortical screws, promoted a better stabilization of bone segments. Locking miniplates presented a better performance in bone fixation in all groups.

Comparative Evaluation of Bone Repair with Four Different Bone Substitutes in Critical Size Defects.

This study evaluated the osteoconductive potential of four biomaterials used to fill bone defects. For this, 24 male Albino rabbits were submitted to the creation of a bilateral 8 mm calvarial bone defect. The animals were divided into four groups-bovine hydroxyapatite, Bio-Oss® (BIO); Lumina-Bone Porous® (LBP); Bonefill® (BFL); and an alloplastic material, Clonos® (CLN)-and were euthanized at 14 and 40 days. The samples were subjected to histological and histometric analysis for newly formed bone area. Immunohistochemical analysis for Runt-related transcription factor 2 (Runx2), vascular endothelial growth factor (VEGF), and osteocalcin (OC) was performed. After statistical analysis, the CLN group showed greater new bone formation (NB) in both periods analyzed (p < 0.05). At 14 days, the NB showed greater values in BIO in relation to LBP and BFL groups; however, after 40 days, the LBP group surpassed the results of BIO (p < 0.001). The immunostaining showed a decrease in Runx2 intensity in BIO after 40 days, while it increased for LBP (p < 0.05). The CLN showed increased OC compared to the other groups in both periods analyzed (p < 0.05). Therefore, CLN showed the best osteoconductive behavior in critical defects in rabbit calvaria, and BFL showed the lowest osteoconductive property.

Oral Rehabilitation with Zygomatic Implants in a Patient with Cleft Palate.

Edentulous patients with an atrophic maxilla associated with lip-palate fissures have unpredictable results after undergoing grafting procedures. In situations where the atrophic maxilla does not adequately allow reconstruction, the use of zygomatic implants has been indicated, and probably these implants can be indicated for the rehabilitation of patients with lip-palate fissures. This case report describes the oral rehabilitation treatment of a patient with a lip-palate cleft treated with zygomatic implants and implant-supported fixed prosthesis with two years of follow-up. A 65-year-old female patient had a lip-palate cleft and previously underwent surgery to close the cleft. The patient had a severely atrophic maxilla and had difficulty adapting to a removable total prosthesis. Due to the small amount of bone remaining and extensive fibrous tissue in the palate region, a rehabilitation with conventional implants associated with zygomatic implants was chosen. Two zygomatic implants and a conventional implant were placed on the right side, and a zygomatic implant and conventional implant were placed on the left side; these implants were later activated by a protocol-type prosthesis. The zygomatic implants provided an adequate aesthetic and functional outcome of the prosthesis in a patient with cleft palate.

Short-term administration of non-selective and selective COX-2 NSAIDs do not interfere with bone repair in rats.

Selective cyclooxygenase-2 non-steroidal anti-inflammatory drugs are known to inhibit bone repair, especially when long-term administration is required due to chronicle inflammatory diseases. In order to evaluate the action of this drug in bone repair during short-term administration, 48 rats underwent surgical bone defects in their tibias, being randomly distributed into three groups: (Group 1) negative control; (Group 2) animals treated with celecoxib, and (Group 3) animals treated with ketoprofen, both experimental groups at 1 mg/kg dose, beginning 1 h before the surgical procedure and after every 12 h for the following 3 days, or until the day of sacrifice. The animals were killed after 48 h, 7, 14, and 21 days. The tibias were removed for morphological, morphometric, and immunohistochemistry analysis for COX-2. No statistical significant differences were observed in the quality of bone repair and quantity of formed bone among the groups. COX-2 immunoreactivity of the celecoxib treated specimens was more intense in the first analyzed period, and no longer observed in the periods of 14 and 21 days. Such results suggest that the administration of the analyzed drugs in short periods does not interfere with the process of bone repair in the tibia of rats.

Decoronation followed by dental implants placement: fundamentals, applications and explanations.

Dental arches areas with teeth presenting dentoalveolar ankylosis and replacement root resorption can be considered as presenting normal bone, in full physiological remodeling process; and osseointegrated implants can be successfully placed. Bone remodeling will promote osseointegration, regardless of presenting ankylosis and/or replacement root resorption. After 1 to 10 years, all dental tissues will have been replaced by bone. The site, angulation and ideal positioning in the space to place the implant should be dictated exclusively by the clinical convenience, associated with previous planning. One of the advantages of decoronation followed by dental implants placement in ankylosed teeth with replacement resorption is the maintenance of bone volume in the region, both vertical and horizontal. If possible, the buccal part of the root, even if thin, should be preserved in the preparation of the cavity for the implant, as this will maintain gingival tissues looking fully normal for long periods. In the selection of cases for decoronation, the absence of microbial contamination in the region - represented by chronic periapical lesions, presence of fistula, old unconsolidated root fractures and active advanced periodontal disease - is important. Such situations are contraindications to decoronation. However, the occurrence of dentoalveolar ankylosis and replacement resorption without contamination should neither change the planning for implant installation, nor the criteria for choosing the type and brand of dental implant to be used. Failure to decoronate and use dental implants has never been reported.

Mandibular angle fractures treated with a single miniplate without postoperative maxillomandibular fixation: A retrospective evaluation of 50 patients.

OBJECTIVE: This retrospective study evaluated the use of a single miniplate for the treatment of mandibular angle fractures (MAF). METHODS: Fifty patients with 53 MAF were treated by open reduction and internal fixation with the use of a single miniplate and were analyzed in this study. RESULTS: Five patients with MAF had postoperative complications that required additional procedures. Three patients had postoperative infection, one patient complained of malocclusion in the first postoperative week, and one patient had miniplate exposure three months after surgery. Every additional procedure was performed in the office under local anesthesia without disruption of the initial fracture treatment. Postoperative maxillomandibular fixation (MMF) was performed in four patients. Treatment of MAF using a single miniplate was effective, with low morbidity and with low rates of postoperative complications. MAF can be treated without MMF, and stability is improved when long miniplates are used. CONCLUSIONS: The use of a single miniplate is therefore encouraged. However, postoperative MMF should be considered with the presence of little contact between bone segments, malocclusion, or extensive tooth loss.

Evaluation of Knowledge of Physical Education Students on Dental Trauma.

INTRODUCTION: Sports' practitioners are vulnerable to dental trauma; if this occurs, the emergency treatment should be fast and efficient. This may be performed by any person at the site of the accident, not only by dental professionals. Physical educators may face dental trauma and should be able to provide proper care. This study had the objective evaluated the knowledge of physical education graduates on dental trauma. MATERIALS AND METHODS: A questionnaire containing questions on dental trauma was applied to 199 physical education students; after collection of the questionnaires, data were tabulated and processed on the software Epi Info 2000 (Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333, USA). As a result, only 36.7% of participants would take the individual suffering trauma to the dental professional, 56.8% believe that the avulsed tooth should be replanted, and 42.2% would replant it. Only 7.5% would store the avulsed tooth in an ideal storage medium for transportation. CONCLUSION: It was concluded that there is a lack of knowledge on dental trauma among physical education graduates, evidencing the need of public policies to allow education on this issue.

Abordagem cirúrgica de lesões vasculares da cavidade oral / Surgical approach of vascular lesions in the buccal cavity

Introdução: As lesões vasculares da cavidade bucal são representadas por hemangiomas ou más-formações vasculares, varizes e menos comumente flebotromboses. Os sítios de maior acometimento são: lábios, mucosa jugal e língua. Os aspectos clínicos são de lesões nodulares ou papulares, pequenas e bem circunscritas, de coloração avermelhada, consistência resiliente, superfície lisa ou moriforme. A diascopia é uma manobra semiotécnica utilizada na diferenciação entre lesões vasculares e máculas. As principais modalidades de tratamento para as lesões vasculares são: excisão cirúrgica, crioterapia, uso de corticóides, escleroterapia e eletrocoagulação. Objetivo: Relatar três casos clínicos de lesões vasculares pequenas na cavidade bucal, tratadas através da excisão cirúrgica das lesões. Resultados e Discussão: Todos os casos evoluíram com um ótimo trans e pós-operatório. O exame anatomopatológico das mesmas revelou dois casos de hemangiomas e um de flebotrombose. A decisão de abordar cirurgicamente as lesões vasculares foi considerada frente aos aspectos clínicos de lesões bem circunscritas, pequenas, palpáveis, boa localização, sem comprometer estruturas nobres anatômicas. Conclusão: A excisão cirúrgica, abordada através de biópsia excisional de lesões pequenas vasculares, é uma opção viável de tratamento, sem complicações trans e pós-operatórias quando corretamente indicadas e executadas.

Introduction: Vascular lesions of the buccal cavity are represented by hemangiomas or vascular malformations, varicose veins and, less commonly, phlebotrombosis. The sites of major involvement are: lips, jugal mucosa and tongue. Clinical features are small, well circumscribed nodular or papular lesions of reddish color, resilient consistency, smooth or moriform surface. Diascopy is a semi-technical maneuver used in the differentiation between vascular lesions and macules. The main treatment modalities for vascular lesions are: surgical excision, cryotherapy, use of corticoids, sclerotherapy, electrocoagulation. Objective: of this present study was to report three clinical cases of small vascular lesions in the oral cavity, which after a well done clinical examination, the team planned the surgical excision of the lesions and the anatomopathological examination revealed two cases of hemangiomas and one of phlebotrombosis. Method: The decision to surgically approach the vascular lesions of this study was considered against the clinical aspects of well circumscribed and small, palpable lesions, good location, without compromising anatomical noble structures. Results: All cases evolved with a good postoperative period. Conclusion: that surgical excision, treated as an excisional biopsy of small vascular lesions, is a viable treatment option, without trans and postoperative complications when correctly indicated and performed.

Transplante Dental Autógeno / Autogenous Dental Transplantation

O transplante dental autógeno pode ser considerado uma opção viável para substituição de dentes perdidos, sendo assim necessário um dente doador em boas condições para sua realização. A principal vantagem dessa técnica é que pode ser realizada em pacientes em fase de crescimento, devolvendo a estética e a função mastigatória para esses pacientes. Este trabalho tem como objetivo relatar um caso clínico de transplante dental autógeno de uma paciente jovem, a qual foi submetida ao transplante do elemento dental 28 para o alvéolo do dente 26, o qual teve indicação de exodontia devido a extensa lesão coronária causada por cárie. O transplante dental autógeno mostrou-se eficaz para o referido caso, visto que proporcionou ao paciente uma reabilitação funcional e estética satisfatória, sendo um tratamento rápido, seguro e economicamente viável.

The autogenous dental transplantation can be considered a viable option to replacement of lost teeth. For this it´s necessary a healthy donor tooth to perform. The main advantage of this technique is can be used in growing patients, reestablishing aesthetics and masticatory function for them. This paper aims report a clinical case of autogenous dental transplantation of a young patient, who was submitted to transplantation from the upper left third molar to the alveolus of upper left first molar, which had indication of exodontia due extensive lesion caused by caries. Autogenous dental transplantation showed to be effective for this case, because the patient had a satisfactory functional and aesthetic rehabilitation, being a fast, safe and economically viable.

Decoronation followed by dental implants placement: fundamentals, applications and explanations

ABSTRACT Dental arches areas with teeth presenting dentoalveolar ankylosis and replacement root resorption can be considered as presenting normal bone, in full physiological remodeling process; and osseointegrated implants can be successfully placed. Bone remodeling will promote osseointegration, regardless of presenting ankylosis and/or replacement root resorption. After 1 to 10 years, all dental tissues will have been replaced by bone. The site, angulation and ideal positioning in the space to place the implant should be dictated exclusively by the clinical convenience, associated with previous planning. One of the advantages of decoronation followed by dental implants placement in ankylosed teeth with replacement resorption is the maintenance of bone volume in the region, both vertical and horizontal. If possible, the buccal part of the root, even if thin, should be preserved in the preparation of the cavity for the implant, as this will maintain gingival tissues looking fully normal for long periods. In the selection of cases for decoronation, the absence of microbial contamination in the region - represented by chronic periapical lesions, presence of fistula, old unconsolidated root fractures and active advanced periodontal disease - is important. Such situations are contraindications to decoronation. However, the occurrence of dentoalveolar ankylosis and replacement resorption without contamination should neither change the planning for implant installation, nor the criteria for choosing the type and brand of dental implant to be used. Failure to decoronate and use dental implants has never been reported.

RESUMO Áreas dos maxilares com dentes em anquilose alveolodentária e reabsorção dentária por substituição podem ser consideradas como portadoras de osso normal, em pleno processo fisiológico contínuo de remodelação; e os implantes osseointegráveis podem ser aplicados com sucesso. A remodelação óssea promoverá sua osseointegração, independentemente de haver raízes em anquilose e/ou em reabsorção por substituição. Após 1 a 10 anos, todos os tecidos dentários terão sido substituídos por osso. O local, a angulação e o posicionamento ideal no espaço para se colocar o implante devem ser ditados pela conveniência clínica associada, exclusivamente, ao planejamento prévio. Uma das vantagens da decoronação com colocação imediata de implantes em dentes anquilosados e com reabsorção por substituição é a manutenção do volume ósseo na região, tanto vertical quanto horizontalmente. Se possível, deve-se preservar, na preparação da cavidade para o implante, a parte vestibular da raiz, mesmo que fina; isso deixará os tecidos gengivais com aspecto de plena normalidade por longos períodos. O importante na seleção de casos para a decoronação é a ausência de contaminação microbiana na região, representada por lesões periapicais crônicas, presença de fístula, fraturas radiculares antigas não consolidadas e doença periodontal avançada ativa. Essas situações são contraindicações para a decoronação. A ocorrência de anquilose alveolodentária e reabsorção por substituição sem contaminação não deve mudar o planejamento para instalação de implantes, nem mesmo os critérios de escolha do tipo e marca de implante dentário a ser utilizado. Nunca foi relatado fracasso na decoronação e uso de implantes dentários.